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Remote Medical Review Nurse Jobs (NOW HIRING)

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Performs medical record review for severity of illness and intensity of service; liaison function ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Aston Carter

Remote Medical Coder

Memphis, TN · On-site +1

$75/hr

Remote Medical Coder Assess and validate AI-generated content related to healthcare operations ... Test AI performance against custom-built scenarios and refine tasks based on quality reviews and ...

Aston Carter

Remote Medical Coder

Jacksonville, FL · On-site +1

$75/hr

Remote Medical Coder Assess and validate AI-generated content related to healthcare operations ... Test AI performance against custom-built scenarios and refine tasks based on quality reviews and ...

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How much do remote medical review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for remote medical review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What is a remote medical review nurse?

A Remote Medical Review Nurse evaluates medical records, treatment plans, and insurance claims to ensure compliance with healthcare regulations and policies. They work from home, reviewing clinical documentation to determine medical necessity, accuracy, and adherence to guidelines. This role often involves collaborating with healthcare providers, insurance companies, and case managers to support appropriate patient care and cost management. Strong clinical knowledge, attention to detail, and experience in utilization review or case management are essential for success in this position.

What are the typical daily responsibilities of a remote medical review nurse?

A Remote Medical Review Nurse primarily reviews patient medical records to ensure accuracy and compliance with clinical guidelines, and evaluates the necessity or appropriateness of treatments and services. They communicate with healthcare providers to clarify documentation or gather additional information and may participate in case discussions with insurance or healthcare teams. Nurses in this role also document findings and recommendations using specialized software and maintain up-to-date knowledge of regulatory requirements. The work is generally autonomous, but collaboration and timely reporting are key parts of daily routines.

What are the key skills and qualifications needed to thrive as a remote medical review nurse?

A Remote Medical Review Nurse must possess a valid RN license, strong clinical knowledge, experience in medical chart review, and excellent decision-making abilities. Familiarity with medical review software, electronic health records (EHRs), and URAC or relevant utilization management certifications are often required. Outstanding attention to detail, time management, and communication skills help set top candidates apart in this remote role. These core and soft skills enable nurses to evaluate medical records accurately, communicate findings clearly, and uphold healthcare quality standards while working independently.

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Remote Medical Review Nurse jobs near you
Infographic showing various Remote Medical Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Medicaid Medical Review RN (Medical Reviewer III)

CoventBridge Group

Remote

$78K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

CoventBridge Group rating

6.7

Company rating: 6.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

310th of 499 rated business services

Job description

Overview
Medicaid Medical Review RN (Medical Reviewer III) - REMOTE
The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage.
In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity System's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Medical Review Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.
Responsibilities/ Requirements
Responsibilities:
  • Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare or Medicaid payment policies
  • Utilizes extensive knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS Level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations
  • Coordinates and compiles the written Investigative Summary Report to the PI Investigator upon completion of the records review
  • Incorporates leadership and communication skills to work with physicians and other health professionals as well as external regulatory agencies and law enforcement personnel
  • Provides training to UPIC staff on medical terminology, reading medical records, and policy interpretation
  • Provides expert witness testimony as required
  • Completes assignments in a manner that meets or exceeds the quality assurance goal of 98% accuracy
  • Maintains chain of custody on all documents and follows all confidentiality and security guidelines
  • Performs other duties as assigned by the Medical Review Supervisor that contribute to UPIC goals and objectives and comply with the Program Integrity Manual and Statement of Work guidelines and CMS directives and regulations

Requirements:
  • 2 years minimum experience with a state Medicaid agency or Managed Care Organization focused in Medicaid
  • 2 years minimum of working knowledge of ICD 10-CM/CPT coding experience
  • 4 years minimum experience auditing claims history or provider files to determine if the claim was payable and if any signed of fraud, waste or abuse are noted
  • Knowledge of, and the ability to correctly identify, Medicare and Medicaid coverage guidelines
  • Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims
  • Ability to read Medicaid claims, both paper and electronic, and a basic knowledge of Medicaid is required
  • Should possess excellent verbal and written communication skills with an ability to write professional summary reports
  • Knowledge of and ability to use Microsoft Word, Excel, and Internet applications
  • Able to efficiently organize and manage workload and assignments
  • Must have and maintain a valid driver' license for the state of residence as on-site audits are part of the role as a nurse reviewer

Educational/Experience Qualifications:
  • Graduate from an accredited school of nursing and have an active license as a Registered Nurse (RN) required
  • Preference given to BSN or higher prepared nurses with recent medical review claims experience in Medicare or Medicaid reviews

Benefits
  • Medical, Dental, Vision plans
  • Life, LTD and STD paid by the employer
  • 401(k) with company match up to 4%
  • Paid Time Off and company paid holidays
  • Tuition assistance after 1 year of service

The salary range for this role is $78,000 to $85,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
About Us:
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.
CoventBridge Integrity Systems is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

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